This article presents a few key pieces of advice from Community Care Inform Children’s guide on motivational interviewing. The full guide sets out how practitioners can adapt this approach to social work practice, including explanations and examples of the key processes involved, and questions to consider when promoting behaviour change. It also provides examples of questions to ask in line with the core counselling skills that underpin motivational interviewing. Community Care Inform Children subscribers can access the full guide here.
The guide was written by Karen Evans, a motivational interviewing trainer, counsellor and supervisor.
What is motivational interviewing?
Motivational interviewing can be defined as a particular way of talking with people about change and growth to strengthen their own motivation and commitment. It was first developed by William Miller (1983) while working in the field of substance misuse, but very quickly its relevance to a wide variety of fields resulted in its application in many countries across the world and in diverse settings and cultures.
Motivational interviewing focuses on the here and now; practitioners look at how the person is feeling and behaving at that moment and notice the difference between this and how the person would like to feel and behave.
Social work practitioners in many scenarios, from safeguarding children to working with older adults with acute and chronic illness, have used the approach. Motivational interviewing has been used with young people in schools and can be applied to direct work with children and families, such as in addressing concerns about domestic abuse, substance misuse and general behaviour change.
Four tasks of motivational interviewing
1. Engaging: This process focuses on building a relationship between the practitioner and the individual. The counselling skills of open questioning, affirming, reflective listening and summarising (known as OARS) begin in the engaging process and continue throughout the whole approach. The person needs to be engaged with the practitioner and their approach before the other tasks can occur. First impressions are important and appropriate body language and eye contact are essential. There are some key ‘traps’ to avoid so that engagement can happen. For example, the ‘assessment trap’ describes the possibility that during the practitioners’ process of gathering information at the initial meeting, the practitioner may ask too many questions and take on an ‘assessor’ role. The practitioner should avoid making the conversation feel like an interrogation. Other ‘traps’ to avoid are explained in the full guide.
2. Focusing: While it is important for practitioners to have an aim and agenda for what they want to address, it is equally important to include issues that the person would like to focus on. This creates a collaborative partnership rather than a hierarchical exchange. It also helps in creating a more relaxed setting and can reduce the level of defensiveness, because the person has a sense of empowerment and control. It is likely that during motivational interviewing you will need to provide information and advice; a helpful structure is to ask, offer, ask. For example:
Ask
- “What things have you tried in the past?”
- “What options have other people tried that you are aware of?”
Offer
- “Is it okay with you if I run through a couple of ideas?”
- “Evidence suggests…” “Research shows….”.
Ask
- “Which one will you think about/try/do?”
More examples are included in the full guide.
Practice point
Practitioners should encourage individuals to explore their thoughts around their behaviour before offering advice. Often practitioners may be limited by time constraints and the pressure to get results, which can result in giving advice too soon. This may mean the person doesn’t have chance to consider their own thoughts and options.
3. Evoking: Practitioners should use an interviewing style in their dialogues, which enables the person to share their thoughts, feelings and opinions. There are several skills the practitioner can use to attempt to draw out more ‘change talk’ (see below for the definition).
Change talk: involves statements that might lead the individual to consider a behaviour change, often related to its harmful consequences or problems.
Evocative questions
- These are direct, often challenging questions. For example: “What worries you about your drinking?”
Looking back
- It can be helpful for people to identify factors that have helped them make changes in the past, either related to the current or previous behaviour. This may help them with current change. For example: “Can you look back to a time when you drank less? What helped?”
Looking forward
- If the practitioner provides time and space to consider a future focus, it can help the person identify a clear idea of where they want to be and the goals towards achieving that. For example: “If I were to see you in a year, realistically what would you like to be telling me about your drinking?”
If the practitioner hears an intention to change, it is important to reflect on this, provide affirmation and explore it further.
- Increased change talk: the person offers more preparatory change talk (which express a desire to change) in their dialogue and possibly also some mobilising language, which shows they are taking steps to change.
- Taking steps: the person takes some small steps towards change. For example, they may find out the details of a support group in the area. The practitioner should affirm these small steps.
- Diminished sustain talk: the person gives less sustain talk at the same time as making more change talk statements.
- Resolve: the person exhibits a quiet resolve towards change.
- Envisioning: the person starts to look at the future situation or self.
- Questions about change: the person starts asking questions about change, demonstrating greater openness towards it.
The practitioner will also assess how the person feels about their behaviour and how close they are to making a change. This assessment of their readiness to change informs the practitioner of the focus of the work and the appropriate skills to use.
The full guide on motivational interviewing includes more information on the core counselling skills that underpin the approach, as well as how to assess readiness to change and integrate motivational interviewing into practice. If you have a Community Care Inform Children licence, log on to read the full guide.
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Motivational interviewing SHOULD be the skills social workers work towards and are taught on a regular basis and used during assessments and the interviewing processes.However Social workers are often not at this stage of intervention with parents because of time constraints, the pressure to demonstrate instant results,social workers are not given the space to build relationships with children and parent’s.
The the norm appears to be one of accepting there will be resistance,hostile engagement and a resistance to engage in any meaningful meetings and or work.Should the question be why this is? and how do we make this better for service users and social workers.
Because the system does not support social workers to provide a professional service due to unmanable case loads,time constrsins ,in some cases complex issues, paper work,learning new systems,attitudes,and in some cases poor pratice and guidance, social workers have lost the core skills of engaging service users.
Social workers attempt to work with the resources to hand,however social workers do not have the power to provide resources and funding to better equipped the profession.
In responce to (pratice point),(focus point 1 and 2) very often motivational interviewing remains at the engagement stage and,hierarchical stages which can then result in care proceedings being initiated because there is no evidence of progression. In some case’s, this then forces service users to engage.
Does this then bring the best outcome for all? Just asking the question!!!
Should we not look at the wider issues of what is preventing engagement?
Are social workers really given the time to prepare for interviewing/assessing service users or is the expectation you will have all the answers in a couple of sessions.In my experince it does not work in this way.
The service needs support from senior management to be in a position to offer the above. Should there not be acknowledgement and steps put in place to address the issues faced by the service inorder to bring back trust in the profession.Ignoring the need for change to both pratice and resources may only cause issues for all.
Is social work not about using our skills,resources,and best pratice to achieve the best out come for all which in turn will reflect a better outcome for all.
These are my observations,option’s based on my own experiences.